Risks and complications of peripherally and centrally inserted intravenous catheters

Increased nursing vigilance is needed while caring for critically ill patients who have i.v. catheters. All i.v. sites should be selected based upon the i.v. therapy needs of the patient, using the shortest catheter and smallest size possible to meet the treatment needs of the patient while avoiding excessive repeated insertions of peripheral IVs. Meticulous handwashing, site preparation, and the use of sterile technique during insertion and maintenance are essential to minimize the risk of infection. Use multilumen catheters only when necessary because these catheters have an increased manipulation and associated infection risk. Observe for signs and symptoms of localized, systemic, mechanical, and metastatic (e.g., vertebral osteomyelitis and endocarditis) foci of infection. Additionally, remove all unnecessary or poorly performing i.v. catheters. I.v. sites that do not yield a blood return but will accept i.v. solutions are in the process of becoming occluded. Most likely, there is a fibrin sheath that is developing along the catheter's inner lumen and opening, decreasing the catheter's effectiveness. Accommodate the need to replace a catheter into the patient's plan of care rather than allowing the catheter to occlude and then replacing it under emergent or rushed conditions.